Insurance Claim Forms

Step 1) During the processing of your compounded prescription, we generate a form, approved by the International Academy of Compounding Pharmacists,www.iacprx.org, for formulas utilizing a prescription ingredient. This is the National Drug Code (NDC#), often referred to on claim forms provided by the insurance companies.

Step 2) Make sure to add your personal information to that form. Make copies of everything and send the form in with your receipt, showing the price you paid for the compound. Often this is sufficient to provide reimbursement.

Step 3) Some providers require their form, in addition to what we provide. Each and every plan has specific requirements, and you may speed up the process by calling their customer service number to get what is necessary for your plan. We have provided some links to a few of the insurance companies listing a form on their site.

Choose Your Insurance Provider:

Insurance Claims Picture

Blue Cross of Georgia

Prescription Drug Claim Form: Blue Cross of Georgia

Print this form and sumbit it to your insurance provider at this address:

 

P.O. Box 9907
Columbus, Georgia
31908-6007

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Medco

Prescription Drug Claim Form: Medco

Print this form and sumbit it to your insurance provider at this address:

Medco Health Solutions, Inc.
P.O. Box 14711
Lexington, KY 40512

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